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<!--
Readers should be aware of the evolving "Using SNOMED CT in HL7 Version 3" implementation guide, currently in a draft state. The guide, co-developed by HL7 and the College of American Pathologists, will be balloted by HL7 as an Informative Document. Recommendations in the final published guide should usurp patterns of SNOMED CT usage found in this sample instance.
-->
<ClinicalDocument xmlns="urn:hl7-org:v3" xmlns:voc="urn:hl7-org:v3/voc" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 CDA.xsd">
	<!-- 
********************************************************
  CDA Header
********************************************************
-->
	<typeId root="2.16.840.1.113883.1.3" extension="POCD_HD000040"/>
	<templateId root="2.16.840.1.113883.3.27.1776"/>
	<id extension="c266" root="2.16.840.1.113883.19.4"/>
	<code code="11488-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC" displayName="Consultation note"/>
	<title>Good Health Clinic Consultation Note</title>
	<effectiveTime value="20000407"/>
	<confidentialityCode code="N" codeSystem="2.16.840.1.113883.5.25"/>
	<languageCode code="en-US"/>
	<setId extension="BB35" root="2.16.840.1.113883.19.7"/>
	<versionNumber value="2"/>
	<recordTarget>
		<patientRole>
			<id extension="12345" root="2.16.840.1.113883.19.5"/>
			<patient>
				<name>
					<given>Henry</given>
					<family>Levin</family>
					<suffix>the 7th</suffix>
				</name>
				<administrativeGenderCode code="M" codeSystem="2.16.840.1.113883.5.1"/>
				<birthTime value="19320924"/>
			</patient>
			<providerOrganization>
				<id root="2.16.840.1.113883.19.5"/>
			</providerOrganization>
		</patientRole>
	</recordTarget>
	<author>
		<time value="2000040714"/>
		<assignedAuthor>
			<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
			<assignedPerson>
				<name>
					<given>Robert</given>
					<family>Dolin</family>
					<suffix>MD</suffix>
				</name>
			</assignedPerson>
			<representedOrganization>
				<id root="2.16.840.1.113883.19.5"/>
			</representedOrganization>
		</assignedAuthor>
	</author>
	<custodian>
		<assignedCustodian>
			<representedCustodianOrganization>
				<id root="2.16.840.1.113883.19.5"/>
				<name>Good Health Clinic</name>
			</representedCustodianOrganization>
		</assignedCustodian>
	</custodian>
	<legalAuthenticator>
		<time value="20000408"/>
		<signatureCode code="S"/>
		<assignedEntity>
			<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
			<assignedPerson>
				<name>
					<given>Robert</given>
					<family>Dolin</family>
					<suffix>MD</suffix>
				</name>
			</assignedPerson>
			<representedOrganization>
				<id root="2.16.840.1.113883.19.5"/>
			</representedOrganization>
		</assignedEntity>
	</legalAuthenticator>
	<relatedDocument typeCode="RPLC">
		<parentDocument>
			<id extension="a123" root="2.16.840.1.113883.19.4"/>
			<setId extension="BB35" root="2.16.840.1.113883.19.7"/>
			<versionNumber value="1"/>
		</parentDocument>
	</relatedDocument>
	<componentOf>
		<encompassingEncounter>
			<id extension="KPENC1332" root="2.16.840.1.113883.19.6"/>
			<effectiveTime value="20000407"/>
			<encounterParticipant typeCode="CON">
				<time value="20000407"/>
				<assignedEntity>
					<id extension="KP00017" root="2.16.840.1.113883.19.5"/>
					<assignedPerson>
						<name>
							<given>Robert</given>
							<family>Dolin</family>
							<suffix>MD</suffix>
						</name>
					</assignedPerson>
					<representedOrganization>
						<id root="2.16.840.1.113883.19.5"/>
					</representedOrganization>
				</assignedEntity>
			</encounterParticipant>
			<location>
				<healthCareFacility classCode="DSDLOC">
					<code code="GIM" codeSystem="2.16.840.1.113883.5.10588" displayName="General internal medicine clinic"/>
				</healthCareFacility>
			</location>
		</encompassingEncounter>
	</componentOf>
	<!-- 
********************************************************
  CDA Body
********************************************************
-->
	<component>
		<structuredBody>
			<!-- 
********************************************************
  History of Present Illness section
********************************************************
-->
			<component>
				<section>
					<code code="10164-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>History of Present Illness</title>
					<text>
						<content styleCode="Bold">Henry Levin, the 7<sup>th</sup>
						</content> is a 67 year old male referred for further asthma management. Onset of asthma in his <content revised="delete">twenties</content>
						<content revised="insert">teens</content>. He was hospitalized twice last year, and already twice this year. He has not been able to be weaned off steroids for the past several months. 
						</text>
				</section>
			</component>
			<!-- 
********************************************************
  Past Medical History section
********************************************************
-->
			<component>
				<section>
					<code code="10153-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Past Medical History</title>
					<text>
						<list>
							<item>
								<content ID="a1">Asthma</content>
							</item>
							<item>
								<content ID="a2">Hypertension (see HTN.cda for details)</content>
							</item>
							<item>
								<content ID="a3">Osteoarthritis, 
									<content ID="a4">right knee</content>
								</content>
							</item>
						</list>
					</text>
					<entry>
						<observation classCode="COND" moodCode="EVN">
							<code code="195967001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Asthma">
								<originalText>
									<reference value="#a1"/>
								</originalText>
							</code>
							<statusCode code="completed"/>
							<effectiveTime value="1950"/>
							<reference typeCode="XCRPT">
								<externalObservation>
									<id root="2.16.840.1.113883.19.1.2765"/>
								</externalObservation>
							</reference>
						</observation>
					</entry>
					<entry>
						<observation classCode="COND" moodCode="EVN">
							<code code="59621000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="HTN">
								<originalText>
									<reference value="#a2"/>
								</originalText>
							</code>
							<statusCode code="completed"/>
							<reference typeCode="SPRT">
								<seperatableInd value="false"/>
								<externalDocument>
									<id root="2.16.840.1.113883.19.4.789"/>
									<text mediaType="multipart/related">
										<reference value="HTN.cda"/>
									</text>
									<setId root="2.16.840.1.113883.19.7.2465"/>
									<versionNumber value="1"/>
								</externalDocument>
							</reference>
							<reference typeCode="XCRPT">
								<externalObservation>
									<id root="2.16.840.1.113883.19.1.2005"/>
								</externalObservation>
							</reference>
						</observation>
					</entry>
					<entry>
						<observation classCode="COND" moodCode="EVN">
							<code xsi:type="CD" code="396275006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Osteoarthritis">
								<originalText>
									<reference value="#a3"/>
								</originalText>
							</code>
							<statusCode code="completed"/>
							<targetSiteCode code="49076000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Knee joint">
								<originalText>
									<reference value="#a4"/>
								</originalText>
								<qualifier>
									<name code="78615007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="with laterality"/>
									<value code="24028007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="right"/>
								</qualifier>
							</targetSiteCode>
							<reference typeCode="XCRPT">
								<externalObservation>
									<id root="2.16.840.1.113883.19.1.1805"/>
								</externalObservation>
							</reference>
						</observation>
					</entry>
				</section>
			</component>
			<!-- 
********************************************************
  Medications section
********************************************************
-->
			<component>
				<section>
					<code code="10160-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Medications</title>
					<text>
						<list>
							<item>Theodur 200mg BID</item>
							<item>Proventil inhaler 2puffs QID PRN</item>
							<item>Prednisone 20mg qd</item>
							<item>HCTZ 25mg qd</item>
						</list>
					</text>
					<entry>
						<substanceAdministration classCode="SBADM" moodCode="EVN">
							<text>Theodur 200mg BID</text>
							<effectiveTime xsi:type="PIVL_TS" institutionSpecified="true">
								<period value="12" unit="h"/>
							</effectiveTime>
							<routeCode code="PO" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration"/>
							<doseQuantity value="200" unit="mg"/>
							<consumable>
								<manufacturedProduct>
									<manufacturedLabeledDrug>
										<code code="66493003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Theophylline"/>
									</manufacturedLabeledDrug>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
					<entry>
						<substanceAdministration classCode="SBADM" moodCode="EVN">
							<text>Proventil inhaler 2puffs QID PRN</text>
							<effectiveTime xsi:type="PIVL_TS" institutionSpecified="true">
								<period value="6" unit="h"/>
							</effectiveTime>
							<priorityCode code="PRN"/>
							<routeCode code="IPINHL" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration" displayName="Inhalation, oral"/>
							<doseQuantity value="2"/>
							<consumable>
								<manufacturedProduct>
									<manufacturedLabeledDrug>
										<code code="91143003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Albuterol"/>
									</manufacturedLabeledDrug>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
					<entry>
						<substanceAdministration classCode="SBADM" moodCode="EVN">
							<id root="2.16.840.1.113883.19.8.1"/>
							<text>Prednisone 20mg qd</text>
							<effectiveTime xsi:type="PIVL_TS" institutionSpecified="true">
								<period value="24" unit="h"/>
							</effectiveTime>
							<routeCode code="PO" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration"/>
							<doseQuantity value="20" unit="mg"/>
							<consumable>
								<manufacturedProduct>
									<manufacturedLabeledDrug>
										<code code="10312003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Prednisone preparation"/>
									</manufacturedLabeledDrug>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
					<entry>
						<substanceAdministration classCode="SBADM" moodCode="EVN">
							<text>HCTZ 25mg qd</text>
							<effectiveTime xsi:type="PIVL_TS" institutionSpecified="true">
								<period value="24" unit="h"/>
							</effectiveTime>
							<routeCode code="PO" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration"/>
							<consumable>
								<manufacturedProduct>
									<manufacturedLabeledDrug>
										<code code="376209006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Hydrochlorothiazide 25mg tablet"/>
									</manufacturedLabeledDrug>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
				</section>
			</component>
			<!-- 
********************************************************
  Allergies & Adverse Reactions section
********************************************************
-->
			<component>
				<section>
					<code code="10155-0" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Allergies and Adverse Reactions</title>
					<text>
						<list>
							<item>Penicillin - Hives</item>
							<item>Aspirin - Wheezing</item>
							<item>Codeine - Itching and nausea</item>
						</list>
					</text>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code xsi:type="CD" code="247472004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Hives"/>
							<statusCode code="completed"/>
							<entryRelationship typeCode="MFST">
								<observation classCode="OBS" moodCode="EVN">
									<code xsi:type="CD" code="91936005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Allergy to penicillin"/>
									<statusCode code="completed"/>
								</observation>
							</entryRelationship>
						</observation>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="56018004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Wheezing"/>
							<statusCode code="completed"/>
							<entryRelationship typeCode="MFST">
								<observation classCode="OBS" moodCode="EVN">
									<code code="293586001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Allergy to aspirin"/>
									<statusCode code="completed"/>
								</observation>
							</entryRelationship>
						</observation>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="32738000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Pruritis"/>
							<statusCode code="completed"/>
							<entryRelationship typeCode="MFST">
								<observation classCode="OBS" moodCode="EVN">
									<id root="2.16.840.1.113883.19.1.2010"/>
									<code code="62014003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Adverse reaction to drug">
										<qualifier>
											<name code="246075003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="causative agent"/>
											<value code="1476002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="codeine"/>
										</qualifier>
									</code>
									<statusCode code="completed"/>
								</observation>
							</entryRelationship>
						</observation>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="73879007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Nausea"/>
							<statusCode code="completed"/>
							<entryRelationship typeCode="MFST">
								<observation classCode="OBS" moodCode="EVN">
									<id root="2.16.840.1.113883.19.1.2010"/>
									<code code="84100007" codeSystem="2.16.840.1.113883.6.96"/>
								</observation>
							</entryRelationship>
						</observation>
					</entry>
				</section>
			</component>
			<!-- 
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  Family History section
********************************************************
-->
			<component>
				<section>
					<code code="10157-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Family history</title>
					<text>
						<list>
							<item>Father had fatal MI in his early 50's.</item>
							<item>No cancer or diabetes.</item>
						</list>
					</text>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="22298006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="MI"/>
							<statusCode code="completed"/>
							<effectiveTime value="1970"/>
							<subject>
								<relatedSubject classCode="PRS">
									<code code="FTH" codeSystem="2.16.840.1.113883.5.111"/>
								</relatedSubject>
							</subject>
							<entryRelationship typeCode="CAUS">
								<observation classCode="OBS" moodCode="EVN">
									<code code="399347008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="death"/>
									<statusCode code="completed"/>
									<effectiveTime value="1970"/>
								</observation>
							</entryRelationship>
						</observation>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="EVN" negationInd="true">
							<code code="275937001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Family history of cancer"/>
							<statusCode code="completed"/>
							<effectiveTime>
								<high value="20000407" inclusive="true"/>
							</effectiveTime>
						</observation>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="160274005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="No family history of diabetes"/>
							<statusCode code="completed"/>
							<effectiveTime>
								<high value="20000407" inclusive="true"/>
							</effectiveTime>
						</observation>
					</entry>
				</section>
			</component>
			<!-- 
********************************************************
  Social History section
********************************************************
-->
			<component>
				<section>
					<code code="29762-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Social History</title>
					<text>
						<list>
							<item>Smoking :: 1 PPD between the ages of 20 and 55, and then he quit.</item>
							<item>Alcohol :: rare</item>
						</list>
					</text>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="266924008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="ex-heavy cigarette smoker (20-39/day)"/>
							<statusCode code="completed"/>
							<effectiveTime>
								<low value="1955"/>
								<high value="1990"/>
							</effectiveTime>
						</observation>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="160625004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Date ceased smoking"/>
							<statusCode code="completed"/>
							<value xsi:type="TS" value="1990"/>
						</observation>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="266917007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Trivial drinker -  less than 1/day"/>
							<statusCode code="completed"/>
						</observation>
					</entry>
				</section>
			</component>
			<!-- 
********************************************************
  Physical Exam section
********************************************************
-->
			<component>
				<section>
					<code code="11384-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Physical Examination</title>
					<!-- 
          ********************************************************
            Physical Exam  - Vital Signs
          ********************************************************
          -->
					<component>
						<section>
							<code code="8716-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
							<title>Vital Signs</title>
							<text>
								<table>
									<tbody>
										<tr>
											<th>Date / Time</th>
											<th>April 7, 2000 14:30</th>
											<th>April 7, 2000 15:30</th>
										</tr>
										<tr>
											<th>Height</th>
											<td>177 cm (69.7 in)</td>
										</tr>
										<tr>
											<th>Weight</th>
											<td>194.0 lbs (88.0 kg)</td>
										</tr>
										<tr>
											<th>BMI</th>
											<td>28.1 kg/m2</td>
										</tr>
										<tr>
											<th>BSA</th>
											<td>2.05 m2</td>
										</tr>
										<tr>
											<th>Temperature</th>
											<td>36.9 C (98.5 F)</td>
											<td>36.9 C (98.5 F)</td>
										</tr>
										<tr>
											<th>Pulse</th>
											<td>86 / minute</td>
											<td>84 / minute</td>
										</tr>
										<tr>
											<th>Rhythm</th>
											<td>Regular</td>
											<td>Regular</td>
										</tr>
										<tr>
											<th>Respirations</th>
											<td>16 / minute, unlabored</td>
											<td>14 / minute</td>
										</tr>
										<tr>
											<th>Systolic</th>
											<td>132 mmHg</td>
											<td>135 mmHg</td>
										</tr>
										<tr>
											<th>Diastolic</th>
											<td>86 mmHg</td>
											<td>88 mmHg</td>
										</tr>
										<tr>
											<th>Position / Cuff</th>
											<td>Left Arm</td>
											<td>Left Arm</td>
										</tr>
									</tbody>
								</table>
							</text>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="50373000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Body height measure"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<value xsi:type="PQ" value="1.77" unit="m">
										<translation value="69.7" code="[in_I]" codeSystem="2.16.840.1.113883.6.8" codeSystemName="UCUM"/>
									</value>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="363808001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Body weight measure"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<value xsi:type="PQ" value="194.0" unit="[lb_ap]">
										<translation value="88.0" code="kg" codeSystem="2.16.840.1.113883.6.8" codeSystemName="UCUM"/>
									</value>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="60621009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Body mass index"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<value xsi:type="RTO_PQ_PQ">
										<numerator value="28.1" unit="kg"/>
										<denominator value="1" unit="ar"/>
									</value>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="301898006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Body surface area"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<value xsi:type="PQ" value="2.05" unit="ar"/>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="386725007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Body temperature"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<value xsi:type="PQ" value="36.9" unit="Cel">
										<translation value="98.5" code="[degF]" codeSystem="2.16.840.1.113883.6.8" codeSystemName="UCUM"/>
									</value>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="364075005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Heart rate"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<value xsi:type="RTO_PQ_PQ">
										<numerator value="86"/>
										<denominator value="1" unit="min"/>
									</value>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="364075005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Heart rate"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071530"/>
									<value xsi:type="RTO_PQ_PQ">
										<numerator value="84"/>
										<denominator value="1" unit="min"/>
									</value>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="364074009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Regularity of heart rhythm"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<value xsi:type="CD" code="248649006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Heart regular"/>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="364074009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Regularity of heart rhythm"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071530"/>
									<value xsi:type="CD" code="248649006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Heart regular"/>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="86290005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Respiratory rate"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<value xsi:type="RTO_PQ_PQ">
										<numerator value="16"/>
										<denominator value="1" unit="min"/>
									</value>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="276362002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Breathing easily"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="86290005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Respiratory rate"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071530"/>
									<value xsi:type="RTO_PQ_PQ">
										<numerator value="14"/>
										<denominator value="1" unit="min"/>
									</value>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="251076008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Cuff blood pressure"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071430"/>
									<targetSiteCode code="368208006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Left arm"/>
									<entryRelationship typeCode="COMP">
										<observation classCode="OBS" moodCode="EVN">
											<code code="271649006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Systolic BP"/>
											<statusCode code="completed"/>
											<effectiveTime value="200004071530"/>
											<value xsi:type="PQ" value="132" unit="mm[Hg]"/>
										</observation>
									</entryRelationship>
									<entryRelationship typeCode="COMP">
										<observation classCode="OBS" moodCode="EVN">
											<code code="271650006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Diastolic BP"/>
											<statusCode code="completed"/>
											<effectiveTime value="200004071530"/>
											<value xsi:type="PQ" value="86" unit="mm[Hg]"/>
										</observation>
									</entryRelationship>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="251076008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Cuff blood pressure"/>
									<statusCode code="completed"/>
									<effectiveTime value="200004071530"/>
									<targetSiteCode code="368208006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Left arm"/>
									<entryRelationship typeCode="COMP">
										<observation classCode="OBS" moodCode="EVN">
											<code code="271649006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Systolic BP"/>
											<statusCode code="completed"/>
											<effectiveTime value="200004071530"/>
											<value xsi:type="PQ" value="135" unit="mm[Hg]"/>
										</observation>
									</entryRelationship>
									<entryRelationship typeCode="COMP">
										<observation classCode="OBS" moodCode="EVN">
											<code code="271650006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Diastolic BP"/>
											<statusCode code="completed"/>
											<effectiveTime value="200004071530"/>
											<value xsi:type="PQ" value="88" unit="mm[Hg]"/>
										</observation>
									</entryRelationship>
								</observation>
							</entry>
						</section>
					</component>
					<!-- 
          ********************************************************
            Physical Exam  - Skin
          ********************************************************
          -->
					<component>
						<section>
							<code code="8709-8" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
							<title>Skin Exam</title>
							<text>Erythematous rash, palmar surface, left index finger.
								 <renderMultiMedia referencedObject="MM1"/>
							</text>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="271807003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Rash"/>
									<statusCode code="completed"/>
									<methodCode code="32750006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Inspection"/>
									<targetSiteCode code="48856004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Skin of palmer surface of index finger">
										<qualifier>
											<name code="78615007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="with laterality"/>
											<value code="7771000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="left"/>
										</qualifier>
									</targetSiteCode>
									<entryRelationship typeCode="SPRT">
										<regionOfInterest classCode="ROIOVL" moodCode="EVN" ID="MM1">
											<id root="2.16.840.1.113883.19.3.1"/>
											<code code="ELLIPSE"/>
											<value value="3"/>
											<value value="1"/>
											<value value="3"/>
											<value value="7"/>
											<value value="2"/>
											<value value="4"/>
											<value value="4"/>
											<value value="4"/>
											<entryRelationship typeCode="SUBJ">
												<observationMedia classCode="OBS" moodCode="EVN">
													<id root="2.16.840.1.113883.19.2.1"/>
													<value mediaType="image/gif">
														<reference value="lefthand.gif"/>
													</value>
												</observationMedia>
											</entryRelationship>
										</regionOfInterest>
									</entryRelationship>
								</observation>
							</entry>
						</section>
					</component>
					<!-- 
          ********************************************************
            Physical Exam  - Lungs
          ********************************************************
          -->
					<component>
						<section>
							<code code="8710-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
							<title>Lungs</title>
							<text>Clear with no wheeze. Good air flow.</text>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="48348007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Chest clear"/>
									<statusCode code="completed"/>
									<methodCode code="37931006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Auscultation"/>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN" negationInd="true">
									<code code="56018004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Wheezing"/>
									<statusCode code="completed"/>
									<methodCode code="37931006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Auscultation"/>
								</observation>
							</entry>
						</section>
					</component>
					<!-- 
          ********************************************************
            Physical Exam  - Cardiac
          ********************************************************
          -->
					<component>
						<section>
							<code code="10223-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
							<title>Cardiac</title>
							<text>RRR with no murmur, no S3, no S4.</text>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="76863003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Normal heart rate"/>
									<statusCode code="completed"/>
									<methodCode code="37931006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Auscultation"/>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN" negationInd="true">
									<code code="88610006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="heart murmur"/>
									<statusCode code="completed"/>
									<methodCode code="37931006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Auscultation"/>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN" negationInd="true">
									<code code="277455002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Third heart sound"/>
									<statusCode code="completed"/>
									<methodCode code="37931006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Auscultation"/>
								</observation>
							</entry>
							<entry>
								<observation classCode="OBS" moodCode="EVN">
									<code code="60721002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Fourth heart sound inaudible"/>
									<statusCode code="completed"/>
									<methodCode code="37931006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Auscultation"/>
								</observation>
							</entry>
						</section>
					</component>
				</section>
			</component>
			<!-- 
********************************************************
  Labs section
********************************************************
-->
			<component>
				<section>
					<code code="11502-2" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Labs</title>
					<text>
						<list>
							<item>CXR 02/03/1999: Hyperinflated. Normal cardiac silhouette, clear lungs.</item>					
							<item>Peak Flow today: 260 l/m</item>
						</list>
					</text>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<code code="282290005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Imaging interpretation"/>
							<statusCode code="completed"/>
							<entryRelationship typeCode="COMP">
								<observation classCode="OBS" moodCode="EVN">
									<id root="2.16.840.1.113883.19.1.3005"/>
									<code code="249674001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Chest hyperinflated"/>
								</observation>
							</entryRelationship>
							<entryRelationship typeCode="COMP">
								<observation classCode="OBS" moodCode="EVN">
									<id root="2.16.840.1.113883.19.1.5505"/>
									<code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH">
										<originalText>normal cardiac silhouette</originalText>
									</code>
								</observation>
							</entryRelationship>
							<entryRelationship typeCode="COMP">
								<observation classCode="OBS" moodCode="EVN" negationInd="true">
									<id root="2.16.840.1.113883.19.1.6675"/>
									<code codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" nullFlavor="OTH">
										<originalText>radiopacities</originalText>
									</code>
								</observation>
							</entryRelationship>
							<reference typeCode="SPRT">
								<externalObservation classCode="DGIMG">
									<id root="2.16.840.1.113883.19.1.14"/>
									<code code="56350004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Chest-X-ray"/>
								</externalObservation>
							</reference>
						</observation>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="EVN">
							<id root="2.16.840.1.113883.19.1.7005"/>
							<code code="313193002" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Peak flow"/>
							<statusCode code="completed"/>
							<effectiveTime value="20000407"/>
							<value xsi:type="RTO_PQ_PQ">
								<numerator value="260" unit="l"/>
								<denominator value="1" unit="min"/>
							</value>
						</observation>
					</entry>
				</section>
			</component>
			<!-- 
********************************************************
  In-office Procedure section
********************************************************
-->
			<component>
				<section>
					<code code="29554-3" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>In-office Procedures</title>
					<text>
						<list>
							<item>Suture removal, left forearm.</item>
						</list>
					</text>
					<entry>
						<procedure classCode="PROC" moodCode="EVN">
							<code code="30549001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Suture removal"/>
							<statusCode code="completed"/>
							<effectiveTime value="200004071430"/>
							<targetSiteCode code="66480008" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Left forearm"/>
						</procedure>
					</entry>
				</section>
			</component>
			<!-- 
********************************************************
  Assessment section
********************************************************
-->
			<component>
				<section>
					<code code="11496-7" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Assessment</title>
					<text>
						<list>
							<item>Asthma, with prior smoking history. Difficulty weaning off steroids. Will try gradual taper.</item>
							<item>Hypertension, well-controlled.</item>
							<item>Contact dermatitis on finger.</item>
						</list>
					</text>
					<entry>
						<observation classCode="COND" moodCode="EVN">
							<code code="14657009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Established diagnosis"/>
							<statusCode code="completed"/>
							<effectiveTime value="200004071530"/>
							<value xsi:type="CD" code="195967001" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Asthma">
								<translation code="49390" codeSystem="2.16.840.1.113883.6.2" codeSystemName="ICD9CM" displayName="ASTHMA W/O STATUS ASTHMATICUS"/>
							</value>
							<reference typeCode="ELNK">
								<externalObservation classCode="COND">
									<id root="2.16.840.1.113883.19.1.35"/>
								</externalObservation>
							</reference>
						</observation>
					</entry>
					<entry>
						<observation classCode="COND" moodCode="EVN">
							<code code="14657009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Established diagnosis"/>
							<statusCode code="completed"/>
							<effectiveTime value="200004071530"/>
							<value xsi:type="CD" code="59621000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Essential hypertension">
								<translation code="4019" codeSystem="2.16.840.1.113883.6.2" codeSystemName="ICD9CM" displayName="HYPERTENSION NOS"/>
							</value>
							<reference typeCode="ELNK">
								<externalObservation classCode="COND">
									<id root="2.16.840.1.113883.19.1.37"/>
								</externalObservation>
							</reference>
						</observation>
					</entry>
					<entry>
						<observation classCode="COND" moodCode="EVN">
							<code code="14657009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Established diagnosis"/>
							<statusCode code="completed"/>
							<effectiveTime value="200004071530"/>
							<value xsi:type="CD" code="40275004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Contact dermatitis">
								<translation code="692.9" codeSystem="2.16.840.1.113883.6.2" codeSystemName="ICD9CM" displayName="Contact Dermatitis, NOS"/>
							</value>
							<targetSiteCode code="48856004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Skin of palmer surface of index finger">
								<qualifier>
									<name code="78615007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="with laterality"/>
									<value code="7771000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="left"/>
								</qualifier>
							</targetSiteCode>
						</observation>
					</entry>
				</section>
			</component>
			<!-- 
********************************************************
  Plan section
********************************************************
-->
			<component>
				<section>
					<templateId root="2.16.840.1.113883.3.27.354"/>
					<code code="18776-5" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/>
					<title>Plan</title>
					<text>
						<list>
							<item>Complete PFTs with lung volumes.</item>
							<item>Chem-7 tomorrow.</item>
							<item>Teach peak flow rate measurement.</item>
							<item>Decrease prednisone to 20qOD alternating with 18qOD.</item>
							<item>Hydrocortisone cream to finger BID.</item>
							<item>RTC 1 week.</item>
						</list>
					</text>
					<entry>
						<act classCode="ACT" moodCode="INT">
							<id/>
							<code code="23426006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Pulmonary function test"/>
							<text>Complete PFTs with lung volumes.</text>
							<entryRelationship typeCode="COMP">
								<act classCode="ACT" moodCode="INT">
									<code code="252472004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Lung volume test"/>
								</act>
							</entryRelationship>
						</act>
					</entry>
					<entry>
						<observation classCode="OBS" moodCode="INT">
							<code code="24320-4" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC">
								<originalText>Chem-7</originalText>
								<translation code="aYU7t6" codeSystem="2.16.840.1.113883.19.278.47" codeSystemName="MyLocalCodeSystem" displayName="Chem7"/>
							</code>
							<text>Chem-7 tomorrow</text>
							<effectiveTime value="20000408"/>
						</observation>
					</entry>
					<entry>
						<act classCode="ACT" moodCode="INT">
							<id/>
							<code code="223468009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Teaching of skills">
								<qualifier>
									<name code="363702006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="has focus"/>
									<value code="29893006" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Peak flow rate measurement"/>
								</qualifier>
							</code>
						</act>
					</entry>
					<entry>
						<substanceAdministration classCode="SBADM" moodCode="RQO">
							<text>prednisone 20qOD alternating with 18qOD.</text>
							<routeCode code="PO" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration"/>
							<consumable>
								<manufacturedProduct>
									<manufacturedLabeledDrug>
										<code code="10312003" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Prednisone preparation"/>
									</manufacturedLabeledDrug>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
					<entry>
						<substanceAdministration classCode="SBADM" moodCode="RQO">
							<text>Hydrocortisone cream to finger BID.</text>
							<effectiveTime xsi:type="PIVL_TS" institutionSpecified="true">
								<period value="12" unit="h"/>
							</effectiveTime>
							<routeCode code="SKIN" codeSystem="2.16.840.1.113883.5.112" codeSystemName="RouteOfAdministration" displayName="Topical application, skin"/>
							<approachSiteCode code="48856004" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Skin of palmer surface of index finger">
								<qualifier>
									<name code="78615007" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="with laterality"/>
									<value code="7771000" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="left"/>
								</qualifier>
							</approachSiteCode>
							<consumable>
								<manufacturedProduct>
									<manufacturedLabeledDrug>
										<code code="331646005" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Hydrocortisone cream"/>
									</manufacturedLabeledDrug>
								</manufacturedProduct>
							</consumable>
						</substanceAdministration>
					</entry>
					<entry>
						<encounter classCode="ENC" moodCode="RQO">
							<code code="185389009" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED CT" displayName="Follow-up visit"/>
							<effectiveTime>
								<low value="20000412"/>
								<high value="20000417"/>
							</effectiveTime>
						</encounter>
					</entry>
				</section>
			</component>
		</structuredBody>
	</component>
</ClinicalDocument>
